The effects of probiotics on gastrointestinal symptoms and microbiota in patients with celiac disease: a systematic review and meta-analysis on clinical trials

Abstract

ObjectivesGluten-free diet (GFD) is the most effective method to manage celiac disease (CD). Many patients do not reach the complete symptom alleviation, even by strict GFD. Recent studies have reported inconsistent results regarding the bene cial bene ts of taking probiotics. Therefore, we aimed to evaluate the effects of probiotics on gastrointestinal (GI) symptoms and the possible underlying causes in CD and celiac disease autoimmunity (CDA) patients. MethodsDatabases, including PubMed, Scopus, Embase, Web of Science and Google Scholar were searched for clinical trials published until July 2022 about assessing the effects of probiotics or synbiotics on CD or CDA patients. We collected data on GI symptoms, CD markers, in ammatory and immune responses, adverse events, and gut microbiota. A random effect meta-analysis was used to estimate the pooled standardized mean difference (SMD) and con dence interval (CI). ResultsWe screened 7234 articles, of which 14 were included in the qualitative analysis and 5 in the quantitative analysis. Probiotics might alleviate GI symptoms, especially in the highly symptomatic patients and improve immune response in CD and CDA patients. Results of the meta-analysis showed that probiotics increased the abundance of Bi dobacterium (SMD:0.72, 95%CI (0.13,1.30) and Lactobacillus (SMD:0.49, 95%CI (0.18,0.80) as compared with placebo. Probiotics did not increase the adverse events compared to the placebo. ConclusionProbiotics might alleviate GI symptoms and immune response and improve dysbiosis in CD and CDA patients. However, high-quality clinical trials are needed to increase the level of evidence. Also, the most suitable combination of probiotics is yet to nd.

From an understanding of etiopathogenesis to novel therapies—what is new in the treatment of celiac disease?

“…Reviews of studies indicate that probiotics may improve gastrointestinal symptoms in patients with CD, moderate the immune response, and improve dysbiosis in patients with CD and autoimmune CD. However, high-quality clinical trials are needed to increase the certainty of the evidence ( Seiler et al, 2020 ; Mozafarybazargany et al, 2023 ). The positive impact of probiotics on CD is primarily attributed to their ability to improve the tightness of the intestinal barrier.…”

Probiotics in Allergy and Immunological Diseases: A Comprehensive Review

“…An agreement was reached among physicians and researchers about the role of probiotics in alleviating gastrointestinal symptoms, especially in symptomatic coeliac disease patients. This strategy is being tested by clinical trials instead of being enlisted as a remission strategy [ 45 ].…”

Prebiotics and Probiotics for Gastrointestinal Disorders

“…The authors reported the quality of evidence was low for the effect of probiotics on overall gastrointestinal symptoms with a high risk of bias. Bifidobacteria levels were increased after the use of probiotics in two meta-analyses [ 158 , 162 ]. Another systematic review reported that a gluten-free diet in children with celiac disease supplemented by probiotic therapy can alter fecal microbiota to typical conditions of healthy individuals and reduce serum pro-inflammatory cytokines [ 163 ].…”